School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
Health Promotion Alliance Cameroon (HPAC), Yaounde, Cameroon.
Syst Rev. 2022 Jun 30;11(1):133. doi: 10.1186/s13643-022-01990-9.
Out-of-pocket expenses have been reported as a major barrier to accessing antenatal care and skilled birth delivery in most of sub-Saharan Africa. Performance-based financing (PBF) is one of several strategies introduced in lower- and middle-income countries to strengthen a weak health system. This review aims to synthesize evidence on the effectiveness of PBF interventions implemented with the objective of reducing out-of-pocket expenses and improving access to and utilization of ANC and skilled birth delivery and family planning in sub-Saharan Africa. It will consider evidence across health sectors and identify gaps in the evidence. METHODS AND ANALYSIS: This protocol is reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline. The systematic review will apply a three-step strategy to search five databases (CINAHL, PubMed, Ovid Medline, EMBASE, Cochrane.) and grey literature with the help of a librarian. Two independent reviewers will conduct screening to determine eligibility and critical appraisal of selected studies using the risk of bias criteria developed by the Cochrane EPOC Group and the New Castle Ottawa Scale for observational studies. The certainty of evidence for the outcomes will be assessed using "Grades of Recommendation, Assessment, Development, and Evaluation" (GRADE) approach. This review will consider experimental and quasi-experimental study designs and observational studies. Studies published in English and French language(s) will be included. Studies published since the introduction of PBF in sub-Saharan Africa will be included. Data will be collected on each item that contributes to out-of-pocket expenses. This review will adopt the Multiple Dimensions of Access Framework to organize the findings.
This systematic review will support evidence-informed data for the performance-based financing community and government by identifying, describing, and assessing the impact of performance-based financing interventions on out-of-pocket expenses in promoting access and utilization of ANC, skilled birth delivery, and family planning across health sectors.
This review has been registered with PROSPERO, Registration number CRD42020222893 .
在撒哈拉以南非洲的大多数国家，自费已被报道为获得产前护理和熟练分娩服务的主要障碍。绩效支付（PBF）是中低收入国家为加强薄弱卫生系统而引入的几种策略之一。本综述旨在综合关于 PBF 干预措施的有效性的证据，这些干预措施的目的是减少自费，并改善获得和利用产前护理、熟练分娩和计划生育的机会。它将考虑整个卫生部门的证据，并确定证据中的差距。
本方案根据系统评价和荟萃分析计划（PRISMA-P）指南报告。系统综述将采用三步策略，在图书馆员的帮助下搜索五个数据库（CINAHL、PubMed、Ovid Medline、EMBASE、Cochrane）和灰色文献。两名独立评审员将进行筛选，以确定合格性，并使用 Cochrane EPOC 小组和纽卡斯尔渥太华量表（针对观察性研究）制定的偏倚风险标准对选定的研究进行批判性评价。使用“推荐、评估、发展和评估”（GRADE）方法评估结果的证据确定性。本综述将考虑实验和准实验研究设计和观察性研究。将包括以英语和法语发表的研究。将包括自撒哈拉以南非洲引入 PBF 以来发表的研究。将收集每个有助于自费的项目的数据。本综述将采用多维获取框架来组织研究结果。
本系统评价将通过识别、描述和评估绩效支付干预措施对促进产前护理、熟练分娩和计划生育的获取和利用的自费的影响，为绩效支付社区和政府提供基于证据的信息。
本综述已在 PROSPERO 上注册，注册号为 CRD42020222893。
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